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Perioperative management protocol for pediatric endoluminal functional lumen imaging probe in esophageal motility
Sherief Mansi1,2, Lev Dorfman1, Khalil El-Chammas1,2
1Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, Ohio, USA.
Insights
A new anesthesia protocol standardizes care for children undergoing esophageal manometry with impedance (EndoFLIP), reducing aspiration risks and procedure time. This approach minimizes anesthesia's impact on esophageal motility during diagnostic and therapeutic interventions for achalasia.
Area of Science:
- Pediatric Anesthesiology
- Gastroenterology
- Surgical Innovation
Background:
- Lower esophageal sphincter achalasia increases aspiration risk during anesthesia.
- Endoluminal Functional Lumen Imaging Probe (EndoFLIP) is crucial for achalasia diagnosis and treatment, requiring anesthesia.
- Anesthesia can alter esophageal motility and EndoFLIP parameters, necessitating standardized protocols.
Purpose of the Study:
- To develop and implement a standardized anesthesia protocol for patients undergoing EndoFLIP procedures.
- To minimize the impact of anesthesia on esophageal motility and reduce perioperative complications.
- To decrease the risk of aspiration in pediatric patients with achalasia.
Main Methods:
- A perioperative management protocol was designed to mitigate anesthetic effects on esophageal motility and prevent complications.
- A retrospective analysis compared pre- and post-protocol implementation data for patients undergoing EndoFLIP.
- Adverse events, procedure duration, and patient demographics were analyzed.
Main Results:
- Post-protocol implementation, there were no adverse events (0/71) compared to 3.3% (2/60) pre-protocol.
- Procedure times were significantly shorter post-protocol (median 79 min vs. 89 min).
- No significant differences were observed in age or gender between the pre- and post-protocol groups.
Conclusions:
- The developed anesthesia protocol offers a standardized approach for administering anesthesia during EndoFLIP procedures.
- This protocol effectively minimizes the impact on EndoFLIP parameters and reduces aspiration risk in achalasia patients.
- The standardized protocol contributes to safer and more efficient patient management.
Objectives:
Lower esophageal sphincter achalasia is associated with a higher risk of aspiration during anesthesia. Endoluminal Functional Lumen Imaging Probe (EndoFLIP) is used as an adjunctive tool in both the diagnosis and treatment of achalasia, for which all children require anesthesia. Anesthesia may affect the parameters of the EndoFLIP due to its effect on gut motility. There are no standard anesthesia protocols to help decrease the risk of aspiration and the undesirable effect of anesthesia on EndoFLIP parameters. This study aims to standardize an anesthesia protocol to target both goals.
Methods:
A protocol was developed to address perioperative management in patients undergoing EndoFLIP for any indication to minimize both anesthetic effect on the esophageal motility as well as perioperative complications. A retrospective data analysis was conducted on patients who underwent EndoFLIP at Cincinnati Children's Hospital Medical Center; pre- and post-protocol implementation data including adverse events was compared.
Results:
Pre-protocol implementation: 60 cases (median age of 13.8 years, 30 [50%] females) with 2 cases of adverse events (3.3%). Post-protocol implementation: 71 cases (median age of 14.6 years, 37 [52.1%] females) with no adverse events (0/71 = 0%). In comparison between pre- and post-protocol cases, no significant difference was noted in gender, age, and adverse events. Post-protocol procedures were found to be significantly shorter (median time of 89 vs. 79 min, p = 0.004).
Conclusions:
Our anesthesia protocol provides a standardized way of administering anesthesia minimizing impact on EndoFLIP parameters and aspiration for patients with achalasia.
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